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Health care disparities exist in the United States. Social inequalities contributing to disparities in health care include poverty, socioeconomic status, being uninsured, one's life course, and being unemployed. Each social inequality has an effect on health status and produces a gradient of poor health and mortality that spans all socioeconomic strata. Selected policies implemented in the United States have resulted in perpetuating health care disparities and negative health outcomes for certain populations. Health care professionals are in a strategic position to implement pragmatic strategies for eliminating some health disparities. Strategies discussed include changes at the following levels: personal, worksite, professional association, community, and civic.

In a climate of ongoing political, economic, technological, and cultural changes in Western, Central, and Eastern Europe, this chapter describes the kinds of changes happening with the health care system and the preparation of health care professionals in one selected country, that of Hungary. Emphasis will be focused on the nursing sub-sector of the health system. Some comparison and contrast will be done between these systems in Hungary and the U.S. Changes will be presented in the context of the European Union and the Bolonga Declaration.

Health promotion programs in global health systems need to incorporate culturally competent care and provide linguistic access. This article describes the challenges in one country, the United States, and reports on research studies, which articulate the current gaps in meeting the above goals. Health care providers are bound by both legal and ethical standards to provide such care. Legal standards are cited. Regardless of legal standards, health care providers are also bound ethically to provide such care. An analysis of basic ethical concepts of principalism is described for the importance of these aspects of care.

The premise of this article is that one cannot have a successful health system without inclusion of culturally competent health promotion programs. And, one cannot have such health promotion programs without an understanding of the role that cultural and linguistic competence plays in the provision of clinically competent and cost-effective services. Not only is there a need for culturally competent care that is legally mandated in some countries, such care is ethically necessary. The first part of this paper will address the need for culturally and linguistically appropriate care and applicable laws and standards. The latter part of the paper will provide an ethical analysis. However, before doing that, one global perspective of health care concerns for underserved populations will be presented as well as a discussion of the importance of the use of ethical frameworks.

“Managed care is the health law issue of 1999” (Leibold, 1999, p. 5). This chapter addresses changes in the health care system initiated by the managed care paradigm — which, in turn, has prompted many legal changes and challenges. Specifically, this chapter will describe the following: (a) an overview of the managed care system versus the traditional fee-for-service system; (b) a selected review of research literature on the strengths and limitations of the managed care system; and (c) a projection of the future trends of the managed care system for patients, consumers, health providers and society. The second area, the review of research literature, will include the impact of managed care on patients, consumers, physicians and nurses. In this chapter, the word patient, means someone who is ill; the word consumer, means someone who has health insurance and may become ill in the future and needs to utilize the health delivery system.